Individual
MR. MICHAEL POULSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 335-5000
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
(574) 335-8707
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71007577A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102507908
ANTHEM
IN
05
—
300007316
—
IN
Enumeration date
03/13/2017
Last updated
03/27/2024
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